Municipality of Meaford Covid-19 Screening Assessment
Every person entering the St. Vincent Community Centre MUST acknowledge that they do not have any of the following symptoms and will have answered NO to the following questions. Should anything change during the season, the Municipality of Meaford asks you to STAY home and contact your local Health unit.  For any questions contact Jesse Bedard at
Sign in to Google to save your progress. Learn more
Email *
This form has been supplied by the Municipality of Meaford and is administered through the Meaford Pickleball Club.  Your information will be held at the Arena, kept confidential and deleted at the conclusion of the pickleball season at municipal facilities.  All players must complete this form prior to stepping on the courts. *
You Name *
Your address *
Phone Number *
Date: *
#1: Do you have any of the following:  Fever or chills? *
New cough or a cough that is getting worse? *
Difficulty breathing? *
Shortness of breath (even when sitting or walking regularly? *
Sore throat (not due to allergies)? *
A runny nose or congested nose (not due to allergies) *
Unusual level of fatique? *
Unusual headache? *
Nausea / vomiting, diarrhea, or loss of appetite? *
Feeling unwell of an unknown reason? *
Has someone you are in close contact with tested positive for COVID-19? *
Have you returned from travel outside of Canada in the past 14 days? *
Do you live with someone who is awaiting COVID-19 tests results who 1) was tested due to symptoms OR 2) was tested due to close contact with someone who tested positive? *
I hereby certify that the information that I have given here in this form is true.   *
If you are signing on behalf of a child, please add their name here.
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy